Introduction
Epilepsy is a nervous system disorder that affects the brain and is characterized by abnormal brain activities, changes in behavior, and alterations in levels of consciousness. During epilepsy, the patient shows unusual movements and becomes unaware of the surroundings. A seizure is a sudden increase in the brain's electrical activity that is uncontrollable by the patient. A person experiencing two or more seizures without any triggering factors within 24 hours is suspicious of having epilepsy. Epilepsy is considered to be one of the most common diseases of the nervous system that affects people of all age groups.
What Is Symptomatic Generalized Epilepsy?
Symptomatic generalized epilepsy is a type of epilepsy in which the patient experiences multiple episodes of seizures, and the level of brain dysfunction is more than the other forms of epilepsy. In symptomatic generalized epilepsy, seizures create disturbances in a generalized pattern involving all the areas of the brain. Most of the patients with symptomatic generalized epilepsy have an already existing brain disorder or injury.
What Are the Causes of Symptomatic Generalized Epilepsy?
The various causes of symptomatic generalized epilepsy are as follows:
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Previous history of a brain injury like trauma or a strong blow on the head.
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Conditions like meningitis (swelling of the outer covering layers of the brain and spinal cord) and encephalitis (swelling of the brain caused due to viral or bacterial infections, insect bites, and other diseases).
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Brain tumor (abnormal growth of cells seen in the brain).
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In some cases, symptomatic generalized epilepsy occurs due to genetic influence, as researchers have linked it to certain genes. It can also occur as a result of a family history of epilepsy.
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Arteriovenous malformations in the brain (tangling of blood vessels that link arteries and veins in the brain).
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Stroke (disturbance in the blood supply to the brain leading to lack of oxygen which in turn results in the death of brain cells).
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Developmental disorders like autism (a disorder of the brain in which way of social interaction, communication, and behavior are different from normal people).
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Brain damage observed in babies before birth may be due to infection in the mother and lack of nutrition.
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Excessive use of alcohol or drugs.
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History of prolonged fever in childhood accompanied by seizures.
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Infections like cerebral palsy (a disorder that is characterized by disturbances in movement, balance, and maintaining posture).
What Are the Symptoms of Symptomatic Generalized Epilepsy?
The symptoms of symptomatic generalized epilepsy can vary from person to person. The symptoms are as follows:
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Uncontrolled vigorous movements of legs and arms that have no purpose.
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The patient loses awareness of the things happening around his surrounding environment.
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Loss of consciousness.
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The patient may experience episodes of fear and anxiety without any triggering factor.
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Weakening of body muscles may cause the patient to fall.
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Muscles that control the eyelid become weakened, leading to sagging of the upper eyelid, and the upper eyelid appears lower than its actual position.
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Uncontrolled and vigorous nodding of the head.
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Staring at a particular object without any reason.
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The body of the patient gets stiffened.
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The patient may experience difficulty in breathing.
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The patient is in a confused mental state.
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Rapid blinking of the eyes.
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Loss of bladder control (inability to control the release or hold of urine).
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The patient does not respond to the voice or touch of nearby people.
How to Diagnose Symptomatic Generalized Epilepsy?
The initial step of diagnosis includes a detailed medical history in which the doctor gets information from the patient regarding his symptoms. The doctor advises conducting some diagnostic tests that are as follows:
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Blood tests:
These are done to find out if the patient has any infection or genetic condition that may be associated with epilepsy.
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Neurological Examination:
The doctor may test the patient's behavior, mental state, and ability to maintain balance and perform basic tasks like walking and running.
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Computerized Tomography (CT) Scan:
In this procedure, x-rays that show cross-sectional images of the brain are obtained. This helps to determine the presence of any tumors, bleeding blood vessels, and other abnormalities in the brain that may be the cause of epilepsy.
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Magnetic Resonance Imaging (MRI):
This test uses large magnets, a computer, and radiowaves to obtain a detailed picture of the brain. It helps to find out the presence of abnormalities in the brain that may be the reason for epilepsy. This test gives a clearer image than a CT scan.
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Electroencephalogram (EEG):
It is one of the most common tests that is conducted to diagnose epilepsy. In this procedure, electrodes are attached to the scalp of the patient to record the electrical activity of the brain. In patients with a history of epilepsy, the brain waves appear to be abnormal. The doctor may monitor and record the seizures when the patient is awake and asleep. This is evident even when the person is not having an episode of epilepsy during the time of the test. This test enables the doctor to find out the nature of the seizure and also to rule out other brain disorders. High-density electroencephalogram is an advanced variant of the conventional electroencephalogram in which the electrodes are placed very closely on the scalp. This test gives more accurate information about the seizures and the regions in the brain affected by the seizures.
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Positron Emission Tomography (PET) Scans:
In this test, a low-dose radioactive material is injected into the vein to detect brain activity and abnormalities present in the brain. Areas with decreased brain activity indicate the regions of seizures.
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Single Photon Emission Computerized Tomography (SPECT):
In this test, a low dose of radioactive material is injected into the vein to obtain a clear three-dimensional view of the blood flow inside the brain. Regions showing a higher amount of blood flow are the areas where the seizures originate. This procedure is done in patients in which MRI and EEG cannot detect the location of the origin of the seizure.
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Statistical Parametric Mapping (SPM):
This method shows the brain areas with higher blood flow than normal areas. This gives idea information about the areas inside the brain where the seizures begin.
How to Treat Symptomatic Generalized Epilepsy?
The different treatment options available to treat symptomatic generalized epilepsy are as follows:
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Medications:
Most people are relieved from the symptoms after taking anti-epileptic medications prescribed by the doctor. In other patients, taking medicines reduces the duration of occurrence and intensity of the seizures. The dosage of the medications is based on the age of the patient and the frequency and intensity of seizures. The doctor may prescribe a low dosage initially that may be increased over time depending on the frequency of seizures. Most of the patients are asked to stop the medications one or two years after the symptoms have disappeared.
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Vagus Nerve Stimulation:
This method is employed when medications are ineffective. This method involves the surgical placement of a device called a vagus nerve stimulator (VNS) below the collarbone in the chest region. Wires or electrodes are connected from the device to the vagus nerve in the neck region. The device sends electrical energy to the brain through the vagus nerve depending on the intensity of the seizure. This method reduces the intensity of seizures by about 40 to 50 percent. Most people who undergo this treatment are still advised to continue the anti-epileptic medicines.
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Deep Brain Stimulation:
In this method, electrodes are placed into specific areas of the brain. These electrodes are connected to a device or generator placed inside the chest. The device sends electrical impulses to the brain at regular intervals. This helps to reduce the severity of seizures.
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Responsive Neurostimulation (RNS):
This involves the surgical placement of a neuro space responsive neurostimulation (RNS) device inside the skull. This device is connected to two electrodes that are placed in the region of the brain where seizures begin. The device detects the activity of the brain and the beginning of seizures. The device records the brain waves and the onset of seizures and sends an electrical charge that stops the seizures.
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Diet Therapy:
This is an effective method employed in children to reduce the episodes of seizures. The ketogenic diet, which is a diet with high-fat content, low carbohydrates, and adequate amounts of protein, is the most common form of diet employed in diet therapy. In this method, the body makes use of energy that is obtained from the breaking down of fats. This diet is started after admitting the child to the hospital, and it may take up to four to five days to get used to the diet pattern. Another form of diet is the modified Atkin's diet which is a less restrictive form of the ketogenic diet.
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Surgery:
This is done in patients with severe seizure attacks that do not reduce with medications. In the surgical method, the doctor may remove a small part of the brain that is responsible for seizures. This method is performed if the portion of the brain responsible for the seizures is very small and the removal does not affect any functions like speech, hearing, or vision. Less invasive techniques like magnetic resonance imaging (MRI) guided stereotactic radiosurgery that uses minimal laser radiation to destroy the specific area of the brain responsible for causing seizures are also being used. Gamma knife radiosurgery is one of the frequently used types of radiosurgery that employs the use of gamma radiations to target a specific area.
Conclusion
Uncontrolled and untreated seizures may affect the life of certain patients severely, which may lead to depression. Hence it is important to educate oneself and family members about the nature of the disease. Early detection and prompt treatment help the patient to lead a normal life. Therefore it is very important to find a doctor at the right time and start a treatment that helps to relieve the symptoms and lead a healthy life.
